质子治疗儿童常见颅内肿瘤疗效和安全性的系统评价和Meta分析

发布时间：2018-03-11 05:03

本文选题：质子治疗　切入点：颅内肿瘤　出处：《中国循证儿科杂志》2017年01期 　论文类型：期刊论文

【摘要】：目的评价质子治疗儿童常见颅内肿瘤的疗效和安全性。方法检索Web of Science、Embase、Cochrane Library、PubMed和中国生物医学文献数据库,检索截止时间为2016年9月,纳入质子治疗儿童常见颅内肿瘤的临床研究。对纳入的文献进行质量评价,采用MetaAnalyst及STATA12.0进行合并分析,对无法合并的结局指标采用描述性分析。结果11篇研究进入系统评价,9篇为病例系列报告,2篇为非随机对照试验,共纳入接受质子治疗的颅内肿瘤患儿531例,颅咽管瘤2篇(45例),星形细胞瘤2篇(59例),髓母细胞瘤4篇(228例),室管膜瘤2篇(120例),未分病理类型报道1篇(79例)。(1)总生存率(OS):分别有5、10和6篇文献报道了2、3和5年OS。2篇非随机对照试验中,3年OS质子治疗组分别为94.1%和94.0%,光子治疗组分别为96.8%和92.5%;1篇报道了5年OS,质子治疗组和光子治疗组分别为82.0%和87.6%。病例系列报告的文献间存在异质性(I250%,P0.1),亚组采取随机效应模型合并,2、3和5年的OS分别为94%(95%CI:0.90~0.97)、90%(95%CI:0.86~0.93)和87%(95%CI:0.82~0.93)。(2)局部控制率(LC):分别有3、4和2篇文献报道了2、3和5年LC,文献间有异质性(I~250%,P0.1),亚组采取随机效应模型合并,2、3和5年的LC分别为93%(95%CI:0.88~0.98)、86%(95%CI:0.81~0.92)和77%(95%CI:0.70~0.85)。(3)第二原发性恶性肿瘤(SMN):4篇文献报道了1例髓母细胞瘤治疗后并发急性髓细胞性白血病。(4)不良反应:9篇文献报道了不良反应,1篇未进行分级报道,8篇文献(465例)报道了3级以上听力损伤16例,3级以上视力损伤6例,需要激素替代治疗的内分泌功能障碍16例。结论质子治疗儿童颅内肿瘤患者前,尚需高质量、大样本的临床验证。
[Abstract]:Objective to evaluate the efficacy and safety of proton therapy for common intracranial tumors in children. The clinical study of proton therapy for common intracranial tumors in children was carried out. The quality of the literature was evaluated, and the combined analysis was performed by MetaAnalyst and STATA12.0. Results A total of 531 children with intracranial tumors who received proton therapy were included in this study. Results there were 9 cases of systematic evaluation and 9 cases of case series reports and 2 cases of non-randomized controlled trials. The overall survival rate of craniopharyngioma (n = 45), astrocytoma (n = 59), medulloblastoma (n = 228), ependymoma (n = 120) and ependymoma (n = 120) were reported. In the 5-year OS.2 non-randomized controlled trial, three years OS proton therapy group (94.1% and 94.0), photon therapy group (96.8% and 92.5) reported 5 years OS, proton treatment group and photon therapy group were 82.0% and 87.6 respectively. There is heterogeneity in the subgroup I250 and P0.1, the OS of the subgroup is 9495 CI: 0.90: 0.9790 and 95CI0.860.993, respectively, and the local control rate of 8795CI0.822: 0.93.LC2: there are 34 and 2 articles respectively reporting 2 / 3 and 5 years, respectively, and there is a heterogeneity between the two groups (P0.1) and the subgroup adopts random effect. The LC of the model combined with the second primary malignant tumor SMMNV and the 5th year's LC were 933 / 95CI: 0.88 / 0.98 and 886 / 895 / 0.92) and 7795 / 95 CI: 0.70 0.85 / 0.85 respectively) the second primary malignant tumor, SMN1: 4 (1 case of myeloblastoma complicated with acute myelocytic leukemia) was reported in 9 articles: 1) adverse reactions were reported in 9 articles. There were 6 cases of hearing loss above grade 3 in 16 cases with visual impairment above grade 3. Conclusion before proton therapy for intracranial tumors in children, high quality and large sample clinical verification is needed.
【作者单位】：兰州大学第一临床医学院;甘肃医学科学研究院肿瘤医院;甘肃医学循证中心;
【分类号】：R739.41

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